Make the Diagnosis: Nerve Concern

(MedPage Today) -- Case Findings: A 63-year-old left-handed male patient presents with tingling in both hands, particularly the left hand. He has struggled to sleep for the past week; after laying down to read, his hand begins to tingle. He reports the tingling only while lying down, he has no symptoms when sitting or standing, and the symptoms resolve quickly once he sits up. He reports symptoms across the whole hand (front and back), but more on the palm than the fingers. The tingling involves all fingers, but is less pronounced on the thumb. There is no muscle weakness, coolness, or discoloration. He reports no swelling or muscle atrophy. The patient ' s history includes rheumatoid arthritis, for which he has been taking methotrexate for a year, and new onset diabetes mellitus. He also reports feeling tingling in his legs when he bicycles for a long time. On exam, the patient reports onset of mild symptoms with his arms raised overhead. There were no neurological findings, and a negative Tinel ' s sign. What is your diagnosis?
Source: MedPage Today Rheumatology - Category: Rheumatology Source Type: news